Comparative outcomes of SCOM/SCOLA vs. IPOM PLUS in Umbilical and para-umbilical hernia repairs

Umbilical and para-umbilical hernias are common abdominal wall defects, often requiring surgical intervention to prevent complications. The Subcutaneous Onlay Laparoscopic Approach (SCOM/SCOLA) and Laparoscopic Intraperitoneal Onlay Repair Plus (IPOM PLUS) are two laparoscopic techniques employed for hernia repair. This study aims to compare these two methods based on surgical time, postoperative pain, seroma formation, hospital stay, and overall cost to guide the selection of appropriate treatment strategies.

This prospective observational study included 60 adult patients with umbilical or para-umbilical hernias treated at a tertiary care hospital between February 2022 and December 2022. Patients were divided equally into two groups, with 30 undergoing IPOM PLUS and 30 receiving SCOM/SCOLA. Surgical outcomes were evaluated based on duration of surgery, postoperative pain scores, seroma formation during the first and third weeks, hospital stay length, and overall cost of care. Statistical comparisons were performed using appropriate tests with p < 0.05 considered significant.

IPOM PLUS demonstrated a significantly shorter mean surgical time (79.13 ± 12.73 min) compared to SCOM/SCOLA (94.53 ± 21.25 min, p = 0.001). Postoperative pain relief was superior in the SCOM/SCOLA group, with significantly lower pain levels observed from the 7th day onward (p < 0.0001). The incidence of seroma was higher in the SCOM/SCOLA group (86.7% in the 1st week) compared to IPOM PLUS (6.7%). By the third week, seroma rates declined to 20% and 3.3% in the SCOM/SCOLA and IPOM PLUS groups, respectively. The IPOM PLUS group had shorter hospital stays (1.83 ± 0.79 days) than the SCOM/SCOLA group (5.07 ± 1.36 days, p < 0.0001). Although IPOM PLUS had higher procedural costs, SCOM/SCOLA incurred greater total costs due to prolonged hospitalization.

Both IPOM PLUS and SCOM/SCOLA are effective surgical techniques with distinct advantages. IPOM PLUS provides faster surgical times, shorter hospital stays, and fewer complications, making it ideal for patients needing rapid recovery. In contrast, SCOM/SCOLA offers better postoperative pain relief and cost-effectiveness per procedure but carries a higher risk of seroma and longer hospital stays. Tailoring the choice of surgical technique to individual patient needs and clinical circumstances can optimize outcomes and resource utilization.